Introduction:
Aims and objective: To explore the trends and correlates of waterpipe use between 2009 and 2017 across the European Union (EU. Methods: We analysed data from waves 72.3 (2009, n=27,788); 77.1 (2012, n=26,751); 82.4 (2014, n=27,801); and 87.1 (2017, n=27,901) of the Eurobarometer survey in all 28 EU member states. Representative samples of EU residents aged ≥15 years were asked to report ever use of waterpipe. Regular waterpipe use, i.e. at least once a month was also assessed in 2017. We used multi-level logistic regression to assess associations of ever and current use with sociodemographic factors.

Results:
The prevalence of ever waterpipe use in the EU increased from 11.6% in 2009 to 16.3% in 2014, but dropped to 12.9% in 2017. Variation between EU member states was observed, ranging from 2.3% (Croatia, 2009) to 41.7% (Latvia, 2017). Regular waterpipe use was highest in Austria (3.6%), Latvia (2.5%) and Belgium (2.0%) in 2017. Those aged 15-24 years were 11.43 times more likely (95% Confidence Interval [CI]: 10.71-12.21) to have ever used waterpipe compared to respondents 55 years and older. Regular and ever waterpipe use were also more likely among current and former cigarette smokers. Males (adjusted Odds Ratio [aOR]=1.64; 95% CI: 1.58-1.70) and those living in urban areas (aOR=1.36; 95% CI: 1.30-1.42) were more likely to have ever used waterpipe.

Conclusions:
A substantial proportion of EU citizens, especially young men, have tried waterpipe. Regular use is relatively limited, but more systematic surveillance is required to monitor trends across the EU.

Funding:
This work was supported by a grant from the European Commission (Horizon2020 HCO-6-2015; EUREST-PLUS: 681109; Vardavas).